The League

Dr. Matthew Prowler
Resident Psychiatrist

Dr. Matthew Prowler

Resident Psychiatrist at The Hospital of the University of Pennsylvania

Using the evidence


The concussing of Colts wide receiver Austin Collie may be the most talked about head injury in the NFL this past week, but it is not singular. There are no fewer than 10 concussions on the NFL's week 15 Injury Report.

You know the disturbing pattern. NFL data support that concussion reports have increased markedly from 2009 to 2010. Even if this rise is due more to the league's increased sensitivity to the problem than to a sudden increase in head injury incidence, the numbers are sobering.

And they alert us all to a different, inconvenient truth - modern American football, the way that it is designed and played, is a brutal sport.

In some ways, the recent unmasking of the devastating effects that chronic brain trauma can cause, has presented the NFL with an existential dilemma - can football be safer and still be football? And what is the NFL to do?

It rightfully falls to the NFL and the NFL Players Association to take the lead in applying current research findings into policy and practice.

There is a new diagnostic tool called the SCAT2, that was developed by experts at the 2008 International Conference on Concussion in Sport, which could help standardize concussion assessments by comparing an athlete's pre-season baseline scores to game-day post-injury scores.

And research into sports-related concussions has suggested that the number three may be an important warning hazard for predicting worrisome long-term effects. A study out of the University of British Columbia compared athletes with no prior concussions to those with one or two, and found no difference between groups in performance on several neuropsychological tests.

A subsequent study from University of Montreal compared short-term memory tasks in athletes with either no prior concussions, 1-2 concussions, or greater than three concussions. They found significantly more EEG brain abnormalities in the 3+ concussion group compared to both of the other groups.

The league could mandate that a player with two concussions in a season have to sit out the remainder of the year. Teams would need to be bigger, and there would be significant financial ripple effects from such a policy. And it is possible that players, as well as football purists, would reject such a plan. But the NFL and NFLPA must now consider hard stances like this.

While a lot more work is undoubtedly needed to make evidence-based short-term and long-term "return-to-play" decisions, these early findings, taken together with longer mandated rest periods, could have an important impact on the safety of the game. It is not enough, but it is a start.

By Dr. Matthew Prowler  |  December 21, 2010; 7:01 PM ET  | Category:  Concussions , Dr. Matthew Prowler , NFL , NFL Rules , Roger Goodell Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati  
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Please email us to report offensive comments.

I was pleased to read your review of the SCAT2 package and the role it can play in assessing payers post concussion relative to return to play decisions and outlining the dangers of concussions. I was equally disappointed however by the focus on just the SCAT2 as if it was the “answer’ to the problem. Hence this email to draw your attention to the NCAA position statement on concussion management which can be reviewed at:

The critical emphasis being that a 3 pronged approach based on symptoms, cognition and balance control is required to understand the impact of a concussion and the resolution of the same. In short, no one test stands alone in the process.

Thank you for your time.

Jon F. Peters, Ph.D.

Posted by: JFPeters | December 22, 2010 10:48 AM

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